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Air travel and chronic obstructive pulmonary disease: a new algorithm for pre-flight evaluation
  1. Anne Edvardsen1,3,
  2. Aina Akerø2,
  3. Carl C Christensen1,
  4. Morten Ryg1,
  5. Ole H Skjønsberg2,3
  1. 1Department of Respiratory Physiology, Glittreklinikken, Hakadal, Norway
  2. 2Department of Pulmonary Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
  3. 3Faculty of Medicine, University of Oslo, Oslo, Norway
  1. Correspondence to Anne Edvardsen, Department of Respiratory Physiology, Glittreklinikken, 1485 Hakadal, Norway; anne.edvardsen{at}


Background The reduced pressure in the aircraft cabin may cause significant hypoxaemia and respiratory distress in patients with chronic obstructive pulmonary disease (COPD). Simple and reliable methods for predicting the need for supplemental oxygen during air travel have been requested.

Objective To construct a pre-flight evaluation algorithm for patients with COPD.

Methods In this prospective, cross-sectional study of 100 patients with COPD referred to hypoxia-altitude simulation test (HAST), sea level pulse oximetry at rest (SpO2 SL) and exercise desaturation (SpO2 6MWT) were used to evaluate whether the patient is fit to fly without further assessment, needs further evaluation with HAST or should receive in-flight supplemental oxygen without further evaluation. HAST was used as the reference method.

Results An algorithm was constructed using a combination of SpO2 SL and SpO2 6MWT. Categories for SpO2 SL were >95%, 92–95% and <92%, the cut-off value for SpO2 6MWT was calculated as 84%. Arterial oxygen pressure (PaO2 HAST) <6.6 kPa was the criterion for recommending supplemental oxygen. This algorithm had a sensitivity of 100% and a specificity of 80% when tested prospectively on an independent sample of patients with COPD (n=50). Patients with SpO2 SL >95% combined with SpO2 6MWT ≥84% may travel by air without further assessment. In-flight supplemental oxygen is recommended if SpO2 SL=92–95% combined with SpO2 6MWT <84% or if SpO2 SL <92%. Otherwise, HAST should be performed.

Conclusions The presented algorithm is simple and appears to be a reliable tool for pre-flight evaluation of patients with COPD.

  • Pulmonary disease
  • chronic obstructive
  • air travel
  • hypoxaemia
  • algorithm
  • oximetry
  • ambulatory oxygen therapy
  • COPD epidemiology
  • COPD mechanisms
  • long-term oxygen therapy (LTOT)
  • pulmonary rehabilitation
  • respiratory measurement

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  • Funding The study was funded by grants from The Norwegian Heart and Lung Patient Organisation and The Norwegian Foundation for Health and Rehabilitation.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by The Regional Norwegian Committee for Medical Research Ethics.

  • Provenance and peer review Not commissioned; externally peer reviewed.